<p> Facilities Consolidation Fund (FCF) Preliminary Application Form</p><p>1. Date: Agency: DMH / DDS (circle)</p><p>2. Name of Sponsoring Organization: </p><p>3. Contact Person / Phone: </p><p>4. Property Location (street,city/town): </p><p>5. Description of Property and Development Plan (i.e. # Units, # Residents – type of work to be done)</p><p>6. Description of Site / Location (i.e. environmental, zoning, proximity to goods, services)</p><p>7. Experience of Sponsoring Organization:</p><p>8. Financing Plan:</p><p>9. Development Team:</p><p>10. Project Schedule:</p><p>11. Population to be Served:</p><p>12. Services Anticipated: 13. Attach Additional Notes or Documents (if any)</p><p>(Complete and return to DMH or DDS Area Housing Coordinator with copy to CEDAC)</p>